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Audit of mortality in upper gastrointestinal bleeding
B D Katschinski1, R F Logan, J Davies
1Division of Gastroenterology, University Hospital Essen, FRG.
Postgraduate Medical Journal
|December 1, 1989
Summary
This study evaluated 1017 patients with gastrointestinal bleeding, finding that advanced age and existing comorbidities significantly impact mortality. Reducing deaths from upper GI bleeding is challenging due to a high proportion of high-risk patients.
Area of Science:
- Gastroenterology
- Internal Medicine
- Clinical Outcomes Research
Background:
- Gastrointestinal bleeding, including haematemesis and malaena, presents a significant challenge in patient management.
- The elderly population is increasingly affected by upper gastrointestinal bleeding events.
Purpose of the Study:
- To prospectively evaluate the outcomes of patients experiencing haematemesis and malaena.
- To identify factors contributing to mortality in patients with upper gastrointestinal bleeding.
Main Methods:
- Prospective evaluation of 1017 patients with haematemesis and malaena over a 2-year period.
- Analysis of mortality rates, causes of death, and patient demographics.
Main Results:
- Overall mortality was 9%, with most deaths occurring in patients over 60 years of age.
- Rebleeding accounted for 14% of deaths, with 5% potentially preventable through improved management.
- 81% of deaths were attributed to concomitant diseases exacerbated by or present before the gastrointestinal haemorrhage.
Conclusions:
- Reducing mortality in gastrointestinal bleeding is hindered by a high prevalence of poor-risk patients, particularly the elderly.
- Improvements in intensive care, transfusion management, and early detection of rebleeding may offer some benefit.
- Concomitant diseases remain the primary driver of mortality in patients with upper gastrointestinal bleeding.